Healthcare Provider Details

I. General information

NPI: 1699349142
Provider Name (Legal Business Name): ABHISHEK MALKAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABHISHEK NITIN MALKAN DO

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
SUMTER SC
29150-4949
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-9680
  • Fax: 803-434-3955
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number83622
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL83622
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: